Department of Neurology. Illinois Neurologic Institute, University of Illinois College of Medicine, Peoria, IL, USA.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Neurol. 2020 Dec;267(12):3763-3772. doi: 10.1007/s00415-020-10100-5. Epub 2020 Jul 28.
Ocular lateral deviation (OLD) is a conjugate, ipsilesional, horizontal ocular deviation associated with brief (3-5 s) closing of the eyes, commonly linked to the lateral medullary syndrome (LMS). There is limited information regarding OLD in patients with the acute vestibular syndrome (AVS). In one case series 40 years ago OLD was suggested to be a central sign. Recently, horizontal ocular deviation on imaging (RadOLD) was frequently associated with anterior circulation stroke and horizontal gaze palsy. Similarly, RadOLD has been associated with posterior circulation stroke, e.g., LMS and cerebellar stroke, but without clinical correlation with OLD.
This is a prospective, cross-sectional diagnostic study of 151 acute AVS patients. Patients had spontaneous nystagmus. Horizontal gaze paralysis was an exclusion criterion. We noted the effect of brief 3-5 s eyelid closure on eye position, and then used the HINTS algorithm (the head-impulse test, nystagmus characteristics and skew deviation) and RadOLD, to establish a correlation between clinical and radiologic findings RESULTS: Of the 151 AVS patients, 100 had a central lesion and 51 a peripheral lesion; 29 of the central lesions were LMS, and 11 had OLD. Additionally, one lateral pontine syndrome had OLD. On opening the eyes 11 patients with OLD and LMS made multiple, hypometric corrective saccades to bring gaze back to straight ahead. 10/11 patients with LMS showed RadOLD.
OLD with multiple hypometric corrective saccades on opening the eyes was infrequent but highly localizing and lateralizing. We emphasize how simple it is to test for OLD, with the caveat that to be specific, it must be present after just brief (3-5 s) eyelid closure.
眼外侧偏斜（OLD）是一种与短暂（3-5 秒）闭眼相关的同向、同侧水平眼球偏斜，通常与外侧髓质综合征（LMS）相关。急性前庭综合征（AVS）患者的 OLD 信息有限。在 40 年前的一项病例系列研究中，OLD 被提示为一种中枢性体征。最近，影像学上的水平眼球偏斜（RadOLD）常与前循环卒中及水平凝视麻痹相关。同样，RadOLD 与后循环卒中有关，例如 LMS 和小脑卒中，但与 OLD 无临床相关性。
这是一项针对 151 例急性 AVS 患者的前瞻性、横断面诊断研究。患者存在自发性眼震。水平凝视麻痹为排除标准。我们观察了短暂 3-5 秒闭眼对眼位的影响，然后使用 HINTS 算法（头脉冲试验、眼震特征和斜偏）和 RadOLD，建立临床和影像学表现之间的相关性。
在 151 例 AVS 患者中，100 例为中枢性病变，51 例为周围性病变；29 例中枢性病变为 LMS，11 例有 OLD。此外，1 例外侧桥脑综合征有 OLD。睁眼时，11 例 OLD 和 LMS 患者进行多次低幅度矫正扫视，使注视恢复正前方。11 例 LMS 患者中有 10 例出现 RadOLD。
睁眼时多次低幅度矫正扫视的 OLD 虽然少见，但具有高度定位和侧化特征。我们强调了测试 OLD 非常简单，但需要注意的是，要具有特异性，必须在短暂（3-5 秒）闭眼后出现。
